The trouble started for Lisa when she took a blood pressure pill and one to control seizures, along with methadone, a drug used to help wean patients off heroin.
鈥淚 inadvertently did the methadone cocktail and I went to sleep for like 48 hours,鈥� Lisa said, rolling her eyes and coughing out a laugh. 鈥淚t kicked my butt. It really kicked my butt.鈥�
The last thing this 46-year-old Somerville, Mass., native remembers is starting to do laundry. That鈥檚 where Lisa鈥檚 daughter found her 鈥� passed out on the washing machine.
鈥淢y daughter brought me up and put me to bed. I hate the fact that she saw me like that,鈥� said Lisa. We鈥檙e not using Lisa鈥檚 last name because she has used illegal drugs and fears going public about that could harm job prospects.
Lisa lay in the same position on the bed 鈥� one leg bent under her body, arms folded across her chest 鈥� for more than a day. Family members checked to make sure she was still breathing. Lisa鈥檚 daughter noticed that her mom鈥檚 right leg had gone white and looked shriveled.
鈥淪he came in and massaged it really, really vigorously,鈥� Lisa said. 鈥淚f she hadn鈥檛 done that, I don鈥檛 think I鈥檇 be walking on this leg. I think I would have killed it.鈥�
As it is, almost five years after the injury, Lisa said she still limps in some weather, 鈥渙r I have what I call flabberfoot. My foot, like, slaps the ground when I walk.鈥�
Lisa never told a nurse or doctor about her injury.
鈥淚 was embarrassed. I didn鈥檛 want anybody to know I had a drug problem,鈥� she said.
Lisa鈥檚 injury may reflect nerve damage, which doctors say is common in people who misuse opioids. Or it may have been the result of something called compartment syndrome, where muscles are damaged or die because blood can鈥檛 get in or out of part of an arm or a leg. In some such cases, the damaged muscles must be removed.
Dr. Ed Boyer聽remembers one such patient, a man who injected heroin while sitting and stayed in that position, leaning to one side, for hours on end.
鈥淲hen he woke up, he had a compartment syndrome of his buttock and they had to remove half of it,鈥� said Boyer, the director of academic development in the emergency medicine department at Brigham and Women鈥檚 Hospital, and a professor at the University of Massachusetts Medical School.
鈥淪o you can have very severe and disfiguring injuries,鈥� he said. 鈥淏ecause now this individual has great difficulty even walking.鈥�
Lingering Damage To Those Who Survive Overdose
The common understanding of patients addicted to heroin or other opioids is that they either survive a high or die, but that there鈥檚 no real damage to those who get up and walk away. Increasingly, emergency room doctors will tell you that鈥檚 not the case.
鈥淚 would say at least 75 percent 鈥� every three of four patients [brought] in after an overdose 鈥� has some sort of associated injury, whether it鈥檚 a minor injury or major injury from that overdose,鈥� said聽Dr. Ali Raja, the vice chair of emergency medicine at Massachusetts General Hospital, the busiest emergency room in the Boston area.
The trauma ranges from frostbite or broken bones after a fall on the ice to serious brain damage. Raja said many injuries from drug use don鈥檛 get treated because patients who are revived never come to the hospital, and those who do are driven by their addiction to leave the hospital quickly and use again.
鈥淭hey often believe that they鈥檙e just fine and they repeat the exact same circumstances that led to the overdose in the first place,鈥� Raja said. 鈥淎nd they鈥檙e definitely prone to repeating the same injuries we just talked about.鈥�
That prompts another question for the emerging science of drug and overdose injuries: What鈥檚 the effect of overdosing again and again?聽Dr. Alex Walley, an associate professor of medicine at Boston University School of Medicine, offers a theory about the impact on the brain.
鈥淥ne way to think about this would be that an overdose is like a concussion, where you have a traumatic injury to the brain,鈥� he said. 鈥淚f the person doesn鈥檛 die, the brain recovers, but they may be, like with a concussion, more susceptible to a future event. And then there also may be cumulative damage that occurs.鈥�
That damage, Walley said, might make these patients more difficult to treat.
Another injury that doctors see among some overdose patients is kidney failure. When a person spends hours in one position, blood stops circulating through muscles and that living tissue can break down, releasing chemicals into the bloodstream.
鈥淭hey can clog up the filtration system in the kidneys,鈥� said Dr. Melisa Lai Becker, chief of the Cambridge Health Alliance emergency department in Everett, Mass. 鈥淎nd when that happens, the kidneys can shut down completely.鈥�
Patients coming out of an overdose often vomit, which can lead to aspiration into the lungs and pneumonia. And then there鈥檚 a condition called pulmonary edema, which hits some patients who are revived 鈥� their lungs fill suddenly with fluid.
鈥淭he lungs become so waterlogged that you can鈥檛 get any more oxygen into the body even though the patient is wide awake and they鈥檙e struggling to breathe,鈥� Lai Becker said.
Doctors offer different theories about why this occurs. Lai Becker said it may be related to a sudden change in blood pressure when a patient is revived abruptly with naloxone. Other doctors think it鈥檚 a reaction to some part of the drug combination patients take.
Emergency doctors have many questions about why this is happening 鈥� it鈥檚 why researchers at the federal聽Centers for Disease Control and Prevention are now wading into this new field of opioid-use injuries, to gather data.
鈥淲e鈥檙e only beginning to scratch the surface and trying to understand what is going on, on this front,鈥� said聽Mark Faul, a senior health scientist at the CDC.
Faul is studying the聽聽between opioid overdoses and traumatic brain injury. He plans to collect data about how often an overdose leaves patients with permanent or temporary brain damage that that can leave them blind or deaf, or with amnesia or other cognitive problems.
Fentanyl Exacerbates The Problems
And there鈥檚 one more complicating factor: fentanyl. This very powerful opioid gives those who use it recreationally a high that is more intense than heroin鈥檚 but wears off more quickly.聽Traci Green, a senior scientist and deputy director of the injury prevention center at Boston Medical Center, said that means recreational drug users tend to use fentanyl more times a day than they would pure heroin.
鈥淚t also means more opportunity to overdose,鈥� she said. 鈥淪imple math tells us that we鈥檙e going to have more visits to the emergency department and we鈥檙e going to potentially have more injury. And injury will beget injury.鈥�
聽can also change the kind of injuries some emergency rooms see 鈥� more falls and head trauma because taking too much of the opioid cuts off breathing immediately and patients collapse. But Lai Becker has a different perspective. She said she has treated fewer of what she calls 鈥渋n between鈥� injuries in the past six months.
On one end of the spectrum, she said, 鈥渨e鈥檙e seeing people who have fortunately had a good, full, complete reversal.鈥� On the other extreme, she added, 鈥減atients have either arrived dead, or we鈥檙e able to resuscitate them, but unfortunately, they鈥檝e already undergone brain death.鈥�
To avoid fentanyl injuries and overdoses, people who are addicted to the drug at least should use it in pairs, Green urges, making sure one partner is stable before the other person injects. She said the state could help, too, by allowing patients who are addicted to opioids to use the drugs in a supervised setting like a hospital or clinic.
鈥淚ndividuals who are able to spend time there don鈥檛 have to worry about hypothermia,鈥� Green said. 鈥淭hey don鈥檛 have to worry about being hit or kicked or struck by a truck. This is something we should consider 鈥� this is a new era of prevention and intervention.鈥�
This story is part of a partnership that includes , and Kaiser Health News.